iHV welcomes new Maternal Mental Health Alliance (MMHA) economic research report which shows that health visiting has a clinically effective and cost-effective role in perinatal mental health care: The economic case for increasing access to treatment for women with common mental health problems during the perinatal period.

 

  • Independent research commissioned by the Maternal Mental Health Alliance (MMHA), conducted by the London School of Economics and Political Science (LSE), estimates the costs and benefits of addressing unmet maternal mental health needs.
  • The report presents the clear economic benefits from training midwives and health visitors in perinatal mental health and enabling their work with pregnant and postnatal women.
  • Changes to standard practice could have a net economic benefit of £490 million over ten years; £52 million in NHS savings and quality of life improvements worth £437 million
  • Universal services such as health visiting and midwifery have a clinically effective and cost-effective role in perinatal mental health care, identifying women in need or at risk, and facilitating access to or providing treatment as part of their routine work with women during and after pregnancy.
  • The report recommends scaling-up integrated provision across the UK as both desirable and viable from an economic perspective.

In a new study commissioned by the MMHA, researchers from LSE evaluated the economic viability of reforming current treatment for pregnant and postnatal women experiencing common maternal mental health problems such as depression and anxiety.

The report, ‘The economic case for increasing access to treatment for women with common mental health problems during the perinatal period’, estimates the costs and benefits of a model of care which could give women’s mental health the same priority as their physical health. The model, which focuses on the essential role of midwives and health visitors, would allow for women’s mental wellbeing to be accurately assessed at every routine contact and suitable treatments to be offered.

The proposed ‘integrated model of care’ would include dedicated maternal mental health training for health visitors and midwives as well as greater collaboration with other healthcare services.

In the report, resources needed to set up and provide this model of care – namely employment and training costs – are measured against their economic return. Researchers conclude that it could lead to cost savings of £52 million for the NHS over 10 years, and improvements in women’s quality of life estimated at £437 million. In total, this is a net benefit of £490 million over 10 years.

Policy analysis by MMHA member, Centre for Mental Health, determines that equitable integrated service provision is the logical and economical next step in the evolution of perinatal mental health care in the UK. It would close a major gap and ensure women get timely access to help for their mental health needs.

Alison Morton, Executive Director iHV, said:

“Even before COVID-19, there were many system challenges to ensuring that all families had access to the right care and treatment, at the right time, for their mental health and wellbeing. Against a backdrop of rising levels of unmet need, we now need to do better. I am therefore delighted to see this robust and long-awaited research published today – it  presents a sound economic case for health visiting, as an  evidence-based solution to some of these challenges, with a fully costed model of care which demonstrates significant savings alongside improving the lives of families experiencing perinatal mental health problems.

“This report is a significant resource for policy makers looking to deliver the Government’s Start for Life commitment to improve parents’ access to perinatal mental health support and give every child  the best start in life. With such clear evidence, it is vital that the Government acts now to strengthen the health visiting service in England as part of an effective integrated system of perinatal mental health support for families.”

Melita Walker, Head of Mental Health iHV, added:

“Mental health problems in the perinatal period are common and as all families have a health visitor, they are ideally placed to offer skilled, professional support quickly when it’s needed. However, current shortages of health visitors make that difficult, and many families are missing out on effective early help for common mental health problems.

“This new report demonstrates that health visiting has a clinically effective and cost-effective role in perinatal mental health care, identifying families at risk of or suffering from mental health problems and facilitating access to, or providing, effective evidence-based treatments as part of their routine work with women and their families during the perinatal period.

“Ensuring all health visitors have the training and time to meet women’s mental health needs is a sound investment that would make a difference to many thousands of women and their families. Furthermore, this timely new economic evidence strengthens the findings and recommendations highlighted in the latest research by Professor Jane Barlow, on the unique leadership role of Specialist Health Visitor in Perinatal and Infant Mental Health in supporting effective integrated PIMH services.”

If we are serious about using sound evidence to make the biggest difference, then going forward we need to:

  1. Build back our health visitor numbers
  2. Ensure all health visitors have appropriate capacity and high-quality training in family mental health
  3. Have a Specialist PIMH Health Visitor supporting families in every Local Authority in England, every Health Board in Wales and Scotland and every Health and Social Care Trust in Northern Ireland.

 

The iHV is delighted to see the #MakeAllCareCount Campaign launched today by the Maternal Mental Health Alliance (MMHA).

Melita Walker, Mental Health Lead at iHV, said:

 “As long-standing active members of the Alliance it has been brilliant to work alongside the fantastic MMHA team and wider Alliance members to help shape the call for a truly integrated system of perinatal mental health care. Family mental health is complex, mental health needs are an enormous public health challenge. The Pandemic has increased the mental health risks for new parents and the already-stretched services supporting their mental health during the perinatal period, so the new focus of the MMHA campaign is needed now, more than ever”.

The #MakeAllCareCount Campaign is calling for:

All women and families across the UK to have equitable access to comprehensive, high-quality perinatal mental health (PMH) care, including and beyond specialist PMH services.

This includes:

  • A confident, well-equipped workforce delivering excellent, safe PMH care and support.
  • Care for all women, including those impacted by inequalities
  • Specialist PMH that meet national standards and act as a catalyst for change within the wider system of care.

Graphic of interlocking wheel with words for MMHA campaign

The new phase of the MMHA’s work to drive change for women and families affected by PMH problems looks at the wider system, including and beyond specialist services, and how to support maternal mental health at every opportunity.

Whilst everyone who comes into contact with women before, during or after pregnancy has the opportunity to provide mental health support, ‘Make all care count highlights and defines the essential services that can dramatically affect the lives of women with, or at risk of, poor maternal mental health. Each essential service in each of the sections of the interlocking wheel above can be explored.

Defining essential perinatal mental health care: health visiting

The campaign recognises the critical role that health visitors have as part of an integrated system of care in achieving good family mental health and wellbeing.

“The campaign is a great opportunity for health visitors (and our partners) to make it clear and be recognised for what we can achieve – if we are in the right numbers with the right competence and capacity.

By making certain that all care is women and family-centred, that there is a competent and confident workforce, by working together and by recognising, liberating and strengthening the unique contribution of each individual/service -we are much more able to ensure that all families across the UK have equitable access to comprehensive, high quality PMH care.”

Do join the call for ALL women and families across the UK to have equitable access to essential, high-quality perinatal mental health care and do tag us in @iHealthVisiting @MMHAlliance  #MakeAllCareCount  #EveryonesBusiness

 

The iHV is delighted to have supported the launch of the new report on maternal mental health and the services that supported women and their families during the COVID-19 pandemic. We would like to put on record our thanks to the Alliance for undertaking this work and creating a public opportunity today for us to come together, to think together about the findings and their important implications for families now – need is great and families can’t wait.

 


Today’s report brings together, for the first time, all of the available data collected during the pandemic looking at the mental health challenges that women during and after pregnancy have faced. The evidence shows a significant increase in maternal mental health problems across the UK over the last 12 months

Speaking at the launch event today, iHV Mental Health Lead, Melita Walker highlighted the important role that health visitors play in identifying and supporting families experiencing mental health challenges, saying:

“Health visitors are qualified nurses or midwives who go on to study at a specialist level in public health to become health visitors. Every family has a health visitor, and they are there to support all members of the family to enjoy good health. Health is affected by a multitude of things so health visitors may be working with families to support a very broad range of need, and those needs, left unsupported as this report shows, can actually tip families into experiencing mental health problems. Health visitors have a vital role in promoting good mental health, preventing mental health problems, identifying them early, offering evidence-based interventions and care coordination when more specialist services are needed. Family mental health and wellbeing is “the bread and butter” of health visiting.

The perinatal period is a vulnerable time for the acute onset and recurrence of mental disorders. When these vulnerabilities are combined with the impact of a pandemic, mental health problems and health inequalities are affected further. We have seen parents struggling with isolation, and sadly, we are seeing an increase in, domestic abuse, child poverty, substance misuse and child maltreatment. Rates of mental health problems are increased and inequalities are widening.  The impact of lockdown has been unevenly distributed and families with lower incomes, from Black, Asian and minority ethnic communities and young parents are experiencing the most detrimental consequences due to compounding factors like overcrowded housing with lack of outdoor space, the effects of poverty, which all have an impact on parental stress, anxiety and predisposition to mental illness. The family centred holistic role of the health visitor cuts across and can make a difference in all of these areas- thus positively and proactively supporting good family mental health alongside a range of other health outcomes.

That said, health visitors can only make a difference if we have sufficient numbers of them and this report highlights that health visitors in England went into the pandemic in a hugely depleted state due to years of cuts to the health visiting service. The first two years of a child’s life are important, and the right support and guidance for families at this time can make a big difference to their long-term outcomes. HVs can be a lifeline for families and the iHV ‘s position from very early on in this pandemic was that there was “more than one frontline” and sustaining support for families’ needed to be a priority and that health visitors should not be redeployed.

It is important to note that many local authorities in England did not redeploy their health visitors, but 65% redeployed at least one health visitor and redeployment ranged from no health visitors being redeployed in some areas, to 63%, of the HV team being redeployed. Over 11% of local authorities lost over a quarter of their HVs. So, we can see, with redeployment rates differing substantially, young children and families’ access to health visiting services was determined by their postcode.

The iHV campaigned vigorously from the outset about redeployment and we were very relieved when England’s chief nursing officer Ruth May , Public Health England & the Local Government Authority sent a letter to all the CNOs stating that HVs provide ‘frontline’ work and should not be redeployed.

The learning we have now, and the swell of collective voices, hopefully means that we can be confident going forward in this and any future pandemic, that health visitors will remain on their own frontline. We are also very optimistic that the Leadsom review will contain some significant measures to strengthen the HV offer for families.

There has been a lot of learning from and throughout this pandemic and we must pay tribute to all the health visitors who continue to work really hard in some very challenging circumstances to find ways to stay alongside families to make sure they receive the care and support they need for their mental health. We have heard of some fantastic examples of health visitors turning to new ways of working and to get all of this up and running in the speed that they have is commendable.

Health visitors are telling us that virtual and digital help has allowed them to reach parents in the absence of being able to visit, and there may well be some of the virtual offers kept after restrictions have eased. They are also telling us very firmly, as is the emerging evidence included in this report, that virtual should not replace face to face contacts.

The research is showing us that there are significant increased MH problems in parents who have experienced becoming a parent during the pandemic. If we are to meet this need then all services need to work together as a system, and all parts of that system need to be strong.

We know a robust home visiting – health visiting service works- we need to build back our health visitor numbers because as this report shows, health visitors are a critical part of the solution for achieving good family mental health and wellbeing”.

Luciana Berger was unanimously voted in as the new Chair of the Maternal Mental Health Alliance (MMHA) at last week’s extraordinary members’ meeting. Luciana takes over the role as Chair from Dr Alain Gregoire on 1 October 2020.

Luciana Berger

Dr Cheryll Adams CBE, Executive Director iHV, commented:

“This is a fabulous appointment for the MMHA and excellent news for all mums and their babies, wherever they live in the UK. Dr Alain Gregoire’s are ‘very big boots to fill’ but we feel very confident that Luciana will do that, bringing her own slant to chairing the MMHA. Very many congratulations Luciana, we very much look forward to working with you to together improve mental health services across the UK for all mums and their families.”

Other MMHA senior role updates on 1 October

Dr Alain Gregoire takes on the new role as Honorary President of the MMHA when he steps down as Chair.

Also, on the 1 October, Emily Slater’s title will change from MMHA Director to CEO. This follows an independent review of MMHA’s management structure and reflects the Board’s expectations of the role as the MMHA has evolved in the last two years.

As an active member of the Maternal Mental Health Alliance (MMHA), the iHV is proud to have supported the new perinatal peer support principles – launched  on 3 December.

Launch of Perinatal Peer Support Principles at Peerfest on 3 December 2019

The Perinatal Peer Support Principles are a set of five values designed to give peer supporters the confidence to create and deliver peer support that meets the needs of women and families affected by mental health problems during pregnancy or the postnatal period.

The principles were co-designed by Mind, the McPin Foundation, and a team of lived experience facilitators, with support from the MMHA. They provide guidance to help ensure that peer support is safe, inclusive, and helpful, and that it meets the unique needs of mothers and babies.

Laura Wood, a mum with lived experience and  one of three lived experience facilitators on this project, said:

“I hope that these principles will make safe, welcoming, nurturing peer support accessible to more mums who need it. I believe that they will, as lived experience has been at the heart of the project. Because the principles were co-created with women and families who have lived through perinatal mental health difficulties, they are shaped around their needs, not what others imagine those needs to be.”

You can access the principles, and a more detailed report, via the Maternal Mental Health Alliance website.

To subscribe to the newsletter and/or enquire about hosting a workshop or event with the perinatal peer support principles, please email [email protected]

We are delighted to announce that this year’s iHV Perinatal & Infant Mental Health (PIMH) Conference will be held in collaboration with the Maternal Mental Health Alliance (MMHA). Taking place on Tuesday 10 September in London, it will focus on the importance of good relationships in perinatal and infant mental health (PIMH) care.

Melita Walker, Mental Health Lead, iHV said:

“In the spirit of relationships, we are delighted to be collaborating with the MMHA to deliver the annual iHV PIMH Conference; Relationships Matter! We have a fantastic programme and we look forward to welcoming delegates to think together about the importance of relationships at every level of PIMH care.”

Together, we will share, discuss and reflect on the latest evidence, research and lived experiences in the context of relationships being fundamental to good parental and infant mental health.

The conference programme is designed to be of value to practitioners working alongside families across the care pathway, those working specifically in mental health, commissioners, local authorities and parents.

Clare Dolman, Vice Chair of the MMHA commented:

“We are delighted to collaborate with iHV on their second annual PIMH conference and look forward to welcoming delegates, hearing from those with experience of PIMH care and discussing opportunities to improve relationships and access to specialist services.”

Dr Alain Gregoire, Chair of the MMHA, will be discussing the importance of relationships in relation to policy, campaigning, practice and experience of PIMH care. There will also be a panel discussion with experts by experience hosted by MMHA’s Champion Network Manager, Maria Bavetta, about how good relationships with care providers can make a real difference to the lives of women and families.

*Early bird rates are available until 7th July 2019, after which standard rates will apply.*

 

 

Despite the stalemate in Stormont, all political parties in Northern Ireland have co-signed a ground-breaking Consensus Statement, drafted as part of the Maternal Mental Health Alliance Everyone’s Business campaign, committing to close the gap in specialist mental health provision for women during pregnancy and the first year after giving birth.

England, Scotland and Wales have faced similar challenges with their specialist perinatal mental health services, but in recent years each have seen significant improvements due to specific and targeted investment. While stakeholders in Northern Ireland have shown support in principal, until now a formal commitment had not been made.

Key facts:

  • Women and families in 80% of Northern Ireland cannot access specialist perinatal mental health community services and there is no Mother and Baby Unit in Northern Ireland.
  • All political parties in Northern Ireland have now officially signed a historic statement agreeing to work together to change this.
  • The Maternal Mental Health Alliance (MMHA) is calling on the parties to unlock urgently needed funding for women and families requiring an inpatient Mother and Baby Unit and specialist community services in every Health Trust.
  • Untreated perinatal mental illnesses can have a wide range of effects on the mental and physical health of women, their children, partners and significant others.
  • In severe cases, perinatal mental illness can be life-threatening: suicide is a leading cause of death for women in the UK during the perinatal period.
  • The economic cost to society of not effectively treating perinatal mental illness far outweighs the cost of providing appropriate services.
  • If perinatal mental health problems were identified and treated quickly and effectively, these serious and often life-changing human and economic costs could be avoided.

The MMHA – a UK-wide coalition of over 90 organisations including the Institute of Health Visiting – together with 18 Northern Ireland-based organisations, including NSPCC NI and AWARE, welcomes the parties’ commitment to deliver life-saving perinatal mental health services in Northern Ireland.

The Maternal Mental Health Alliance (MMHA), the Institute of Health Visiting (iHV),  the Royal College of Obstetricians and Gynaecologists (RCOG), and the Royal College of Midwives (RCM) are delighted the NHS Benchmarking report on Universal Perinatal Mental Health Findings was published on Friday 14 September.

Prior to this study, information on service provision and staffing of universal perinatal mental health (PMH) services was not available at a national level. The study sought to gain an understanding of the extent of PMH provision in universal services across England, supplementing an annual audit of Specialist PMH services undertaken by the NHS Benchmarking Network for NHS England.

The data collected from providers suggested that:

  • Capacity in universal services is very limited and does not provide the necessary broad base from which the Specialist PMH services can operate effectively and efficiently as a secondary care tier.
  • The provision of specialist perinatal mental health care within universal services is highly variable across England, with some areas having no, or limited, provision (obstetric & midwifery providers 61%; health visiting providers 30%).

Specialist provision within universal services is necessary to coordinate, inform and support evidence based PMH care across the whole service, and therefore offers a clear reflection of the care women are able to access. The large gap in health visiting PMH capacity was particularly evident, with 70% of providers having no specialist provision within the service.

If we are to deliver on the ambition of the Five Year Forward View for Mental Health, attention must be paid to the full spectrum of need. This report is critical because it focuses on the universal element, where the vast majority of women need to receive their care. Most recognition of mental health problems and risks, most prevention and early intervention, can only be coordinated and provided within universal services. Universal services are therefore a crucial element of the PMH care pathway at every local level and have the potential to create great savings in relation to both human and economic costs in the short and long term.

Dr Cheryll Adams, Executive Director at the iHV, said:

 “The Institute of Health Visiting warns that the real state of today’s health visiting support for mothers suffering with perinatal mental illness (PMI) may be significantly worse than that found by the NHS Benchmarking report based on data from 2016, as there have been further cuts to the workforce and the development of a significant postcode lottery of services up and down the country. Health visitors across the country nevertheless continue to strive to deliver an excellent service to children and families, and will do everything in their power to promote good family mental health.”

 Alain Gregoire, Chair of the MMHA, said:

“There has been excellent progress in funding specialist perinatal service provision across England, but we know that specialist services alone are not enough. All women in pregnancy and postnatally should have equitable access to the support, prevention and treatment they need for their mental health as much as for their physical health. This report shows that investment is essential to ensure that there are sufficient, well-trained staff across universal services so that women get the care they should expect from the NHS, and our children can get the best start in life.”

Janet Fyle, Professional Policy Advisor at the Royal College of Midwives, said:

“Whilst there is progress in some areas, there is still a lot more to do.  Our survey showed that we remain seriously short of specialist maternal mental health midwives and services to support women with mental health problems and needs in the community and in their homes. There is also a need to ensure that all midwives involved in the care of pregnant women receive adequate training, so that they can identify women with mental health problems and refer them appropriately for care and support as required.”

Dr Alison Wright, Consultant Obstetrician and Vice President of the Royal College of Obstetricians and Gynaecologists said:

“Despite maternal mental health being a key priority of the Government, this report shows the extreme pressure faced by obstetricians and psychiatrists, midwives and health visitors who provide perinatal mental healthcare. Healthcare professionals are usually the first point of contact that a woman reaches out to and we must ensure that all staff involved in the care of women during pregnancy and beyond, have the relevant education and training in perinatal mental health. Every maternity unit across the country should have in place a clearly defined care pathway for referring women to local specialised perinatal mental health services which all women can access when needed.”

Collectively, we will continue to push for equitable access to evidence based PMH care for women with mental health problems and their families through robust universal services alongside the development of specialist PMH services – women and their families need both. We support the call for all maternity and health visiting services (and GP services) to be sufficiently resourced, so that all professionals across universal services have sufficient capacity, competence and confidence to deliver top quality proactive mental health care to all families. Furthermore, we advocate that these healthcare professionals should be supported by having lead specialist professionals/Champions from within their respective professions in every organisation.

Background Information to the report

In January 2017, the NHS Benchmarking Network was commissioned by Health Education England, funded by NHS England, and partnered with the iHV, RCOG and RCM to complete a stocktake of perinatal mental health (PMH) care within maternity and health visiting services. Data collection took place from February to May 2017 and referenced the year January to December 2016. Universal PMH services in this report included obstetrics, midwifery and health visiting.

There was a high response rate from organisations across England, with numbers of responses by service type as follows:

  • Obstetric services 141
  • Midwifery services 123
  • Health visiting services 88

 In total, the following specialist practitioners were identified in the study:

  • Obstetric services = 40.8 WTE (1.3% of total obstetric capacity)
  • Midwifery services = 228 WTE (1.4% of total midwifery capacity)
  • Health Visiting services = 60.6 WTE (0.78% of total health visiting capacity)

This year’s theme is Diversity – understanding and reaching the missing families.

  • Date: Thursday 6 September 2018
  • Location: Imperial College London

The Maternal Mental Health Alliance (MMHA), of which the iHV is an active member, hopes the 2018 conference will start a conversation about diversity and provide an opportunity to focus on identifying and breaking down the barriers to mental health services for everyone.

The conference will:

  • provide an overview of the latest research on families experiencing barriers in accessing perinatal mental health support
  • highlight the latest thinking and interventions to meet the needs of hard to reach communities
  • share the stories of women from diverse backgrounds
  • bring together practitioners and experts from adult, child, maternity, social care, early years and perinatal mental health services to discuss diversity and perinatal mental health problems
  • showcase Mums and Babies in Mind (MABIM), Everyone’s Business and Maternal Mental Health Alliance and A Better Start (ABS)

New maps launched today by the Maternal Mental Health Alliance’s Everyone’s Business Campaign show that pregnant women and new mums in a quarter of the UK still cannot access lifesaving specialist perinatal mental health services, which meet national guidelines.

The Maternal Mental Health Alliance welcomes the encouraging signs of progress seen in some parts of the UK but raises the alarm: there is not progress for all parts of the country at the same rate, meaning right now, women and families still face a postcode lottery.

According to the new data, pregnant women and new mums in 24% of the UK still have no access to specialist perinatal mental health services (rated red on the map). The maps show that whilst many more women now live in an area coloured green on the map, meaning specialist perinatal mental health services are available in their locality, it is unacceptable that so many women and their families still cannot access essential care.

More than 1 in 10 women develop a mental illness during pregnancy or within the first year after having a baby. Women with the most severe perinatal illnesses need to be able to access vital specialist services wherever they live. If left untreated these illnesses can have a devastating impact on women and their families. In the most serious cases, perinatal mental illness can be life threatening: suicide is a leading cause of death for women during pregnancy and one year after giving birth.

When a woman lives in an area where she is able to access specialist services, with a team of trained staff, it can make all the difference to her quality of care, speed of recovery and support both for her and relationships with her baby and family.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“The Institute of Health Visiting is fully committed to supporting  the Maternal Mental Health Alliance’s Everyone’s Business Campaign and, as active members of the Alliance, the Institute is delighted to see the progress which has been made to provide access to specialist perinatal mental health services for all mothers.

“It is unacceptable that there is still a lack of parity for mental health in the perinatal period and that suicide is still a leading cause of maternal death. These new maps show that much has been achieved, and the great strides are to be applauded – but we must press on, there is still much to do to turn the map green.

“Women with severe perinatal illnesses require timely referral to specialist perinatal mental health services, and health visitors are crucial – to not only accessing specialist perinatal mental health services, but they also work upstream, often preventing a potential mental health problem becoming a mental health crisis/severe mental illness. Thus, alongside supporting the call for continued funding of specialist perinatal mental health services, the Institute is urging additional investment to ensure there is a confident, competent, capable and committed universal health visiting service at every local level.

“To ensure that every mother (and her family) does indeed, get the right help, in the right place, at the right time, we need properly funded and supported pathways of care at every local level. It is most definitely #everyonesbusiness”